Pediatricians Urged To Treat Ear Infections More Cautiously

Giancario Gemignani-Hernandez, 2, of Pittsburgh has his ear examined by Dr. Alejandro Hoberman.

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Originally published on February 25, 2013 4:40 pm

Hoping to reduce unnecessary antibiotics use, the American Academy of Pediatrics on Monday issued new guidelines for how doctors should diagnose and treat ear infections.

Every year, millions of parents take their children to the pediatrician for ear infections, and most of them end up going home with antibiotics. In fact, ear infections are one of the most common reasons kids see doctors and the leading reason kids get antibiotics.

"Parents, if their child is up all night screaming and tugging the ear, they want something to make the child feel better," says Dr. Richard Rosenfeld of the State University of New York Downstate Medical Center, who helped write the new guidelines.

But about 70 percent of children get better on their own within two or three days, and about 80 percent are better within a week to 10 days, he says.

And he says there are some real downsides to using antibiotics when they're not necessary: They can cause upset stomachs, allergic reactions and other problems. And they can contribute to the development of superbugs — infections that are getting harder and harder to cure.

"The bacteria that do survive the antibiotic get tough, and next time you get an ear infection or any other type of infection, they're harder to manage," Rosenfeld says.

The first thing the new guidelines say is: Make sure the child really has an ear infection.

"There are dozens of reasons an ear can hurt," Rosenfeld says. "In this guideline we say, 'Listen, if you're not sure of the diagnosis, don't even think about giving an antibiotic. Please, don't even think about it.' "

The only way to know for sure is to take a close look at the eardrum and see if it is clearly bulging.

"If it's pushed outward — looks like it wants to pop — that is a very, very accurate sign of an ear infection," Rosenfeld says.

But even kids who really do have ear infections don't necessarily need antibiotics. The guidelines say doctors have the option of just watching kids who don't have intense pain, a high fever or other symptoms of a severe infection.

"You don't have to freak out as a parent. [Ear infections] tend to go away on their own quite often with just some pain medicine," Rosenfeld says.

But there are some kids who definitely should get antibiotics, such as those ages 6 months to 2 years who have infections in both ears or any child who has severe symptoms, such as severe pain for several days and a fever of at least 102.2 degrees. Any child who has a ruptured eardrum should also get antibiotics, according to the guidelines.

"If you have a severe infection, no point discussing it further. Those children are going to get antibiotics. And the reason is they'll get the most benefit," Rosenfeld says.

Other experts praised the guidelines. But some worry they might make some doctors a little too hesitant to use antibiotics.

"When the diagnosis is correct, then antibiotic treatment is never wrong," says Dr. Ellen Wald of the University of Wisconsin School of Medicine and Public Health in Madison. "Kids tend to recover more often and they recover more quickly if they're treated appropriately with antibiotics."

That's especially important for working parents, Wald notes.

"We live in a society where there is so much pressure for both parents to be working outside the home and it's just complicated when our child is sick. Besides which, there's always parental anxiety and concern when their child is sick," she says.

Rosenfeld stresses that doctors are free to figure out the best way to treat each child. In many cases, they can give parents a "safety net" or "wait and see" prescription and say: "Hold on to this antibiotic. Give some pain medicine the first day or two. And if they're not better after two days, then we do want you to let us know and start the antibiotic," Rosenfeld says. "But if they are better, just throw it out and they'll do fine."

The new guidelines also recommend ways parents can protect their kids from ear infections in the first place, such as by breast-feeding and keeping kids away from cigarette smoke.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

We have new advice today for parents and doctors dealing with ear infections. It's a common problem for kids, and one of the most common solutions is the use of antibiotics. The American Academy of Pediatrics says the antibiotics are being used too much. Here's NPR's Rob Stein.

ROB STEIN, BYLINE: Every year, millions of parents take their children to the pediatrician for ear infections, and most end up going home with antibiotics. In fact, ear infections are the leading reason kids get antibiotics.

DR. RICHARD ROSENFELD: Parents - if their child is up all night screaming and tugging the ear, they want something to make the child feel better.

STEIN: But ear specialist Richard Rosenfeld says most kids would get better on their own, often just in a few days. And there can be some real downsides to using antibiotics: They can cause upset stomachs, allergic reactions and other problems. And they can create superbugs - infections that are getting harder and harder to cure.

ROSENFELD: Bacteria that do survive the antibiotic get tough, and next time you get an ear infection or any other type of infection, they're harder to manage.

STEIN: So the American Academy of Pediatrics is issuing new guidelines designed to get doctors to use antibiotics only when they're absolutely needed. The first thing they say is, make sure the child really has an ear infection.

ROSENFELD: There are dozens of reasons an ear can hurt. In this guideline, we say: Listen, if you're not sure of the diagnosis, don't even think about giving an antibiotic. Please, forget about it.

STEIN: The only way to know for sure is to take a close look at the eardrum.

ROSENFELD: If that eardrum is bulging - if it's pushed outwards, looks like it wants to pop - that is a very, very accurate sign of an ear infection.

STEIN: But even a lot of kids who really do have ear infections don't necessarily need antibiotics if there aren't any severe symptoms, like lots of pain or a high fever.

ROSENFELD: You don't have to freak out, as a parent. They tend to go away on their own, quite often ,with just some pain medicine.

STEIN: But there are some kids who definitely should get antibiotics: younger kids who have infections in both ears; or any kid who has really bad symptoms, like a fever of at least 102.2; or kids whose eardrums are ruptured.

ROSENFELD: If you have a severe infection, no point discussing it further. Those children are going to get antibiotics. And the reason is, they get the most benefit.

STEIN: Other experts praise the new guidelines. But some, like Beth Wald of the University of Wisconsin, worry they might make some doctors too hesitant to use antibiotics for kids who really need them. [POST-BROADCAST CORRECTION: Dr. Wald's first name is Ellen, not Beth.]

DR. ELLEN WALD: When the diagnosis is correct, then antibiotic treatment is never wrong. Kids tend to recover more often, and they recover more quickly, if they're treated appropriately with antibiotics.

WALD: There is so much pressure for both parents to be working outside the home, and it's just complicated when your child is sick; besides which - you know, there's always parental anxiety and concern when their child is sick.

STEIN: Rosenfeld stresses that doctors are free to figure out the best way to go for each child. They can always send parents home with what's called a safety net, or wait-and-see prescription.

ROSENFELD: And say, you know, the odds are very great that your son or daughter is going to get better in the next three days. Hold onto this antibiotic. Give some pain medicine the first day or two. And if they're not better after three days, then we do want you to let us know and start the antibiotic. But if they are better, just throw it out - and they'll do fine.

STEIN: And the new guidelines make one other important point: They recommend ways parents can protect their kids from ear infections in the first place, such as breast-feeding and keeping them away from cigarette smoke.